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Rural Gujarat's public healthcare services witness 7.9 per cent decline, one of the highest in India: Niti Aayog experts

By Rajiv Shah
In fresh evidence, Gujarat’s public healthcare has taken a beating over the last10 years, with rural areas witnessing one of the sharpest 7.9 per cent fall in the provision of government health services in India, Only two states witnessed a higher fall than Gujarat in rural public healthcare services -- Karnataka (13.2 per cent) and Maharashtra (9.5).
Based on an analysis of National Sample Survey (NSS) conducted in 2004 (60th round) and 2014 (71st round), a recent study, put on the Government of India’s (GoI's) Niti Aayog website, the data show that Bihar was No 1 state, where confidence in rural public healthcare delivery system rose by a whopping 28 per cent, followed by Assam (15 per cent), Haryana (12.7 per cent), Uttarakhand (7.7 per cent), and so on.
The study has been carried out four experts, three of whom are with the GoI – Nishant Jain, Deputy Program Director at German Development Cooperation, India; Alok Kumar is Adviser (Health) at NITI Aayog; Sunil Nandraj is Adviser (Clinical Establishments Act) to Ministry of Health and Family Welfare; and Kheya Melo Furtado works as Young Professional (Health) at NITI Aayog.
In the urban areas, too, Gujarat’s public health services have shown a fall, but at a lesser pace than the rural areas – by 2.8 per cent, as against the national average of fall of 6.2 per cent.
Giving an analysis of outpatient and inpatient facilities, the study, taking rural and urban areas together, says, “In nine out of the 21 states, the share of public sector facilities in outpatient care has decreased; in six states it has improved marginally while there have been impressive gains in six states.”
The study praises some of the poorer states, saying, “The best results are from Assam, Uttarakhand, Odisha, Chhattisgarh and Jharkhand which suggest that investments in public healthcare facilities are likely to yield far better results in those areas where there is a dearth of private healthcare facilities due to paying capacities, terrain or other factors.”
As for the inpatient facilities, the study states, “The picture is even more dismal for inpatient care, with 12 out of 20 states in rural areas and 17 out of 21 states in urban areas registering a decline in the share of the services provided by government-owned facilities.”
The study observes, “One way to interpret these results could be that in view of greater investments on public health facilities in rural areas, the declining trend of people availing public health-care facilities could be arrested, but this was not so in urban areas due to limited investments in government facilities.”
It adds, “But another equally compelling argument could be that there is a general preference among people for private providers; financial resources permitting and adequate choice of providers being available. The plausibility of the latter argument is buttressed by data showing a steady decline in the reliance upon public providers with a rise in urban monthly per capita expenditure (UMPCE).”
However, the study says, “The expenditure on healthcare by governments (union and states) has increased by more than four times in nominal terms, but the share of patient load for hospitalized care in government facilities has remained practically static in rural areas (41.7% to 41.9%) and steadily declining in the urban areas (38.2% to 32%).”

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